Provider Demographics
NPI:1730915448
Name:SMITH, RHONDA (MA, RESIDENT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-8183
Mailing Address - Country:US
Mailing Address - Phone:919-339-6317
Mailing Address - Fax:
Practice Address - Street 1:3915 BLENHEIM BLVD STE 23A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2432
Practice Address - Country:US
Practice Address - Phone:703-259-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional